Evaluation of biliary dyskinesia in diabetic patients with and without autonomic neuropathy and factors affecting it

Diabetes mellitus is known as one of the factors causing the cholesterol gallstone. Though the pathophysiologic mechanisms of this phenomenon are unclear, hypotheses such as reduced gallbladder motility were presented to explain the higher incidence of gallstones in diabetes. The aim of our study was to study gall bladder motor function in diabetic patients with and without autonomic neuropathy to reach the pathogenesis of gallbladder dysfunction in diabetic patients and to correlate GB dyskinesia with demographic features [Age, sex, BMI Body Mass index and waist to hip ratio], duration of illness, fasting and two hours post-prandial blood glucose levels, lipogram and type of antihyperglycemic drugs. Our study included fifty persons, 30 type 2 diabetic patients divided into two groups, group [A] included 15 patients with autonomic neuropathy and group [B] included 15 patients without autonomic neuropathy, and 20 age matched healthy persons. All studied groups were subjected to the following: Careful history and clinical examination, measurement of body weight, height, and BMI. Measurement of waist circumference and hip circumference, calculation of waist/hip ratio and assessment of Cardiovascular autonomic function by the bedside tests of Ewing et al. [1985], which are: Heart rate response to standing, heart rate response to Valsalva maneuver, heart rate response to deep breathing, systolic blood pressure response to standing, diastolic blood pressure response to sustained hand grip. Fasting and two hours post-prandial blood glucose levels with follow up for 3 months, liver function tests, lipogram, blood urea and serum creatinine. Abdominal ultrasonograhy and Tc99m hepato-immuno-diacetate hepatobiliary scintigraphy after 6 hours fasting and 30 minutes after fatty meals for 30 minutes to measure the gallbladder ejection fraction. The results of our study revealed that GBEF was lower in type 2 diabetic patients in comparison with the control group. It was also found that GREF was lower in diabetic patients with autonomic neuropathy than in those without. In our study we discovered that GBEF was lower in type 2 diabetic patients with autonomic neuropathy than in those without and there is inverse correlation between GBEF and fasting and after two hours blood glucose levels. We did not find any correlation between the duration of diabetes mellitus and GBEF probably because of the small sample of patients with long duration and no correlation was found between GBEF and demographic features or lipogram. Furthermore, we did not find a significant correlation between GBEF and the type of antihyperglycemic drugs